Abstract
Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with psychological, social, and economic costs. Measures are needed that complement lockdowns and reduce adverse effects. Epidemiological studies, to date, have identified high-risk populations, but not workplaces appropriate for closure. This study was conducted to provide evidence-based measures that used exact and reliable follow-up data of the PCR-positive COVID-19 cases to complement lockdowns. The data are not subjected to selection or follow-up biases, since the Japanese government, by law, must register and follow all the PCR-positive cases until either recovery or death. Direct customer exposure may affect the quantity of viral inoculum received, which, in turn, may affect the risk of the severity of disease at infection. Therefore, the professions of the cases were grouped according to their frequency of direct customer exposure (FDCE) based on subjective observations, which resulted in five workplaces; hospital, school, food service, outdoor service, and indoor office being identified. Analyzing the follow-up data, we obtained precise estimates for the risk of severe disease, defined as intensive care unit (ICU) hospitalization or death, for the workplaces adjusted for age, sex, family status, and comorbidity. Major findings are as follows: hospital and school are the lowest risk, food and outdoor services are, despite higher FDCE, safer than indoor office. Unemployed and unclear are the highest risk, despite low FDCE. These results suggest the following workplace-specific measures complementing the lockdown: school should not be closed and indiscriminate closing of food and outdoor service industries should be avoided, since it would be more effective to reinforce their efforts to promote adherence to public health guidelines among students and customers. These actions would also reduce the adverse effects of the lockdown. This study is the first to address the causality between the workplaces and severe disease. We introduce FDCE and adherence to public health guidelines (APHGs) to associate the workplace characteristics with the risk of COVID-19 severity, which provided the basis for the measures complementing lockdowns.
Highlights
The novel coronavirus disease 2019 (COVID-19), first appeared in Wuhan, China at the end of 2019, spread globally and as of March 11, 2021 has resulted in 2,624,677 deaths worldwide [1]
Severe rates in stage 1 are approximately determined by corresponding severe rates in stage 0 plus random errors, irrespective of the levels of the variables
Prioritizing Cases According to the Risk of Disease Severity
Summary
The novel coronavirus disease 2019 (COVID-19), first appeared in Wuhan, China at the end of 2019, spread globally and as of March 11, 2021 has resulted in 2,624,677 deaths worldwide [1]. In addition to this loss of life, measures to control the spread of the disease have resulted in the severe economic consequences for citizens and countries around the world [2]. Different efforts of the countries to control its spread include a variety of management techniques such as travel bans, quarantines, lockdowns, and mask mandates [3]. The pandemic had not abated and the prevalence and mortality due to the COVID-19 in 27 countries failed to show a significant decline 15 days after the lockdown compared to the 15 days before the lockdown [2]
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